If you are among the many Americans joining Medicare’s ranks this year, you have this to anticipate: health care insurance decisions. It’s a subject that can be treated as drudgery, a common perception, or as an opportunity be a winner.
So many choices, so many decisions. You will have about two dozen Medicare Advantage plans and 10 types of Medicare supplement (Medigap) policies to consider. A Senior Health Insurance Benefits Assistance (SHIBA) volunteer counselor could assist.
These are among the changes and considerations for Marion and Polk county residents in 2024:
- Of the Medicare Advantage plans delivering both medical and prescription drug benefits, 12 charge no monthly premium (up from nine plans in 2023). Plans can charge no premium or relatively low premiums because Medicare subsidizes the premiums by more than $800 a month for everyone regardless of income.
- Medicare Advantage plans have a ceiling that limits how much the insured could be required to pay for medical services during the year. Among zero-premium plans, the lowest out-of-pocket ceiling was $4,500 in 2023. This year, one plan dropped that to $3,450.
- With many zero-premium Medicare Advantage plans last year, the insured paid $90 for a hospital emergency room visit. A $120 co-pay is more common this year.
- Medicare Advantage insurance companies are increasingly competitive in offering benefits that Medicare doesn’t offer. Among them are cash allowances for dental procedures and approved over-the-counter purchases, home-delivered meals following a hospital stay, medical-related transportation and of course long-offered gym memberships.
- If these “extra” benefits interest you, it’s worthwhile to compare them. For example, companies offering a dental allowance have a range from $350 to more than $2,000. Before enrolling in a plan with such benefits, call to ask for specifics about using the benefit (even better, when calling ask to see detail on the company’s website or to have it mailed to you).
- Some Medicare Advantage companies are offering surprisingly large sums for hearing aids. Ask the company what stores and brands you would be required to use, then compare that cost against what you might find on the open market.
- People who don’t drive may benefit from a plan that offers medical-related transportation. Three Medicare Advantage plans that offered this benefit in 2023 do so again this year, including one that charges no monthly premium. Here, too, be sure to obtain the details.
- Insurance companies usually give their Medicare Advantage plans names such as Choice, Value, Elite and so forth. This year, one company uses only numbers (such as 0002) to differentiate among its plans. Confusing.
- In the past, if one went to temporary skilled nursing after temporary hospitalization (including three midnights) for an illness or injury, the Medicare beneficiary would have no cost for the first 20 days. That remains true of Medicare. With Medicare Advantage plans, a few now levy a $10-a-day co-pay during those first 20 days.
- Some Medicare beneficiaries take no prescription drugs, yet they know it’s a good idea to enroll in drug insurance to avoid a late-enrollment penalty later. With most Medicare Advantage plans, drug coverage is included. For those beneficiaries who want a plan covering prescription drugs only, this year one plan has no monthly premium – and no other plan surpasses its star rating.
But wait! At the outset you read that, instead of drudgery, this Medicare insurance business could be a chance to feel like a winner. It can, too, if you treat this health and financial decision as you would the purchase of a car, household furniture or appliances and put in some time to do the research.
Besides Medicare Advantage insurance, other Medicare coverage options are Original Medicare (that is, Medicare Parts A and B only) and Medicare supplement (Medigap) policies. Whatever type is chosen, be sure your doctors will bill your choice and that the plan or policy covers your prescription drugs at a price satisfactory to you.
If you would like to make an appointment with a SHIBA volunteer counselor, or to ask a question to be answered here, please see below.
Jim Sellers of Salem is a certified Medicare counselor with the Senior Health Insurance Benefits Assistance (SHIBA) program. To ask a question to be answered in this column, e-mail [email protected]. To schedule a free SHIBA phone, Zoom or in-person appointment with a volunteer Medicare counselor, call 800-722-4134.
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